Fracture appliance



July 27, -1943. H. L. BlsNoFF 2,325,300

FRACTURE APPLIANCE Filed Nov. 2, 1942 5 Sheets-Sheet l INVENTOR #Af/ yMA/OFF A TORNEYv July 27, 1943- H. L. BlsNoFF 2,325,300

FRACTURE APPLIANCE Filed Nov. 2, 1942 5 Sheets-sheet 2.

INVENTOR @www ,QW

ATTORNEY July 27, 1943. H. BlsNoFF FRACTURE APPLIANCE Filed Nov. 2, 19423 Sheets-Sheet 3 54m/OF5 ATTORNEY Patented July 27, 1943FRACIUREAPBLIANC y Harry L. Bisno, JamaicapN. Y.A

" 'Application November 2, 1942, seriall No. Genes j 6cialmsfl.'`12e-e7) l This,inventionrelatesto anappliance for use in the treatmentof, malformations; dislocations, fractures and diseases of the jaws, 'aswell as bone structures contiguous thereto;

An important object 'of thepresent invention is to provide an applianceofthe character alv luded to, which is simple in construction, permitsof a Wide range of adjustment' andusage, enables a ready shifting of theaccessory appended elements customarily employed in conjunction withapparatus of this character, and is capable of such diverseand numerousapplicationsas to substantially preclude the use' of other appliancesheretofore employed.v Y

`More specifically, the present Vinvention involvesa headband adaptedbyvery simple means andv equally' simple manipulation, to engage orreceive in anyone -of a plurality of! positions therealong, supporting,Ytraction, retention or oompressionwires or implements, and otherinstrumentalities usually availed of in the treatl ment of fractures,dislocations, malformations, etc., ofthe bone structures abovereferredtol For instance, fractures of the `mandible `and maxilla are ofcommonY occurrence, and yfre'- quently accidents producing suchfractures also produce fractures,v impactions, etc., of the palate,maler and nasal' bones.y Furthermore, these fractures may be simple,singular, multiple, `bilateral, Cempound'orcomminuted. They may betransverse; vertical', or oblique; or the "parts may b'e'separated'bylcrushing or there may be loss of bone due to the incursion of vbonynecrosis, and so on. It will be apparent that the number and diversityo'i'devices and instrumentalities,required tdhandle such variegatedpathological and surgi, calI states wouldfordinarily be imposingyto saythe least'. l

It the commendable virtue of my appliance that 'it provides aninstrumentality for simply copine- With a large number' of suchconditions which have vheretofore required sometimes cumbersome, if notmultipla-apparatus, as well `as requiring' val very expert technique` Itwill be apparentjthere'iore, that an appliance sogarnenabletoreadyfadaptability under such -diverse complications isof the utmostprofes-f sional utility, and it is this Veryv adaptability andversatility that is stressednherein as of the essence of thev presentinvernzion., v

For example; iii-any case where fractures or separations, etc.; occur,`it isthe common procedure toresort to what is known as intradental orvinterden-tal wiringgorjto apply a splint made of-varieus materials,erto` employ bandages.- In

the'case ofswiring', a Wire `is looped yaround 'one` or moreteeth onfeachside' of thev `fracture as well zas around one: or'fmoreteeth ofthe opposite jaw vto vlering;-` theparts into propenpositive occlusion.Where. there is displacement of a fragmentsor partofrthe `jaw,laterally7 anteriorly,-or4 posteriorly, or overriding,zfit isxthepractic'efto rst endeavor to reset the so-displacedy part into 'its'normal position, and apply. xation in the manner above described;Enterdental -wiringnis only one or themeansemployedfor splintingl l the4fracturedfmemloer.; casting, ligation and other means vfor,bringingthelpa'rts .into alignment bej ingemployed; co'ordingto the necessitiesofl the case.r Interdental wiring frequentlyv is ,not enoughtractionpressure; or whatever, must be applied irl-order to assureproperocclus'alap; postion'betweenthe teethof the upper andlower jaws; hence).the upper and lower jaws are usually Wired together; as by interdentalv-wirin'gwith traction, etc. Butv this tractio-nvis. ordinarily nosimple business; sovvhe're interdentalv wiringv is.

employed auxiliary to external traction,a 'loop is twisted in ,theAlinterdental wiringl and made to project through' the 'mouth inY orderthatf-itv may proper degree and-direction i of traction" (support,v Y

retention or' pressure)v may beeiected, without change `in'"structureofrm'yappliancefas ywill'be presently-illustrated. 1

In. the accompanying drawings, my appliance is 'showmboth in detailconstruction, and as applied to thecor'rection or treatment of various`bone l structures of the face. 1

YFig; -1 isa front View'oil'my device arranged'to eect lateral "tractionon the'maxilla or mandible, as the; case may b'ewith the chin support'in position. l l

Fig; 2 is aside-View of Fig. l, showing inaddition Aa Ilateroposteriorly*disposed traction Wire. 'Fi'gf Lluis a`partially"pseudcsaggfital section of a human skull with my appliancein'sectional View on'the-line 3--3 of Fig; 1;

Fig.V 45'-`ifs-a"threequarter rear view of 4my de-l vice i-nwhichthechin and head straps havelbee'n dispensedv'vithlV V Fi-g. frisl afrontupperthreequarter'view show-'1 mg' rey-headband with chin strapslattaehed, and carrying 'l al s lidable bracket or 'yoke supportingattachments for' correcting nasal deformities;

tion, a latero-posterior traction Wire or device.

Fig. '7 is a side View of my headband, in part, with a suitableattachment supported by overhead tape'or strap, which attachmentsupports tension or traction wire, elastic, etc., for exerting tractionor tension of the maxillae or malar bone or other structures.

Fig. 8 is'a partial side view of my headband with attachment for use inthe support, retention or alignment of thepalate. y i

Fig. 9 is a partial side view of my headband with attachment forcorrecting nasal deformities and the like.

Fig. 10 is a modification of Fig. 7, and showing a smaller attachmentfor use closer to the face, and used similarly to Fig. '7.

y Throughout the drawings, like .numerals indicate like parts.

My device comprises a headband I not quite entirely encircling the head.At the rear, the headband is bifurcated'at both ends, the upperextensions 2,-"2, embracing vthe back of the head on' a line,approximately, withthefront portion of the headband," or the back part`of the crown of the headjfwhile the lower extensions 3, 3, slantdownwardly Vand underneath the back or vocciput of the' head.Adjustablestraps 4, 4, pivotally rivetedat one end as at 4a, unite therespective extensions to each other, and enable the headband to `beadjusted to a wide range of sizes and variable inclinationsof extension3, 3. The inorder to provide right, left, or directly forward (anterior)traction. The member I5a extending from the traction wire I5 to the loopISa of the interdental wiring I6 may consist of a rubber band or wire Ifthe member I5a -be a rod, obviously the traction wire I5 may also beadjusted for compression or retention.

In Fig. 2, there is shown another traction wire I'I, the ends of whichare disposed in perforations 8, 8, toward the rear ofthe band 1. Saiddevice I'I also extends downwardly. The function thereof, as clearlyillustrated in said Fig. 2, is to exert traction on the posteriorportion I8 of the mandible, fractured as shown, substantially across theangle of that bone, or for any fracture in the mandible or maxilla.requiring backward traction. A screw ISI is shown as temv porarilyembedded in the bone Structure of fragside `oiE :the headband is linedwith felt, cotton,

.9: is also ystitched or otherwise attached to the frontof theheadband,extendingvertically above and.v between theleyes, theperforationstherein being rlocatedzone abovethe other.

`In, order more securely to position or stabilize theheadband on thehead, straps VIl),.are provided (see Figs. 1,2, 3, 5, 7, 8, 9 and 10,for example). ,In order to provide for further possible implementationof the device,two pieces of leather VII,-are stitched tothe headband insuch a wayas to provide means thro-ugh which wires, ligature, tape orthe like may be-passed andthus stored for ready access (seeparticularlyFigs. 1

and 5). l v 5 A chin cupA I2is also provided for supporting the mandibleor lower 'jaw and is connected to the headband by straps I3a,- I3b,respectively, two on each side. The posterior straps I3?) may be.attached at their upper ends to buckles/or loops I4, Which are in turnpivotally attached to the headband, so as to enable the said rearstrapsISb, to swivel and thereby permit oblique orA vertical. support.`There are also provided loops I4c to which the straps I3b may beattached, if so desired. v l;

It will be seen from the several figures that the prime purpose of theperforated band 1 is to provide a convenientinstrumentality forIreceiving, engaging or accommodating-the laterally bent ends of tractionwire I5, and other similarly bent attachments, which maybe inserted intoany pair of holes in the-series of perforations 8, 8, in said band. Thetraction wire I5 may be readily shifted .from one side to therother innient I8, which screw is connected by a traction| tie Wire, rod orrubber band 20, to the traction device i l. rThis latter arrangement isusually employed where there has been what is known as an overridingfracture, traction being required to be placed on thev posteriorfragment to vmaintain or bring the latter into alignment with the mainbody of themandible. For this purpose also a hole may be drilled throughthe bone and a wire passed through and connected toy the tractionbar-51;

It should be noted that the traction wire which I employis preferably ofsuch character as .to be readily lbent intodesiredfform or shape and yetresilient enough to apply the necessary degree of traction orcompression as andfwhen required.

In the vertical perforations of the strip 9 ink the fore-part oftheheadband (see Figs. 1, 3, 5 and 8),` are adapted tobe inserted, asshown in Fig. 3v particularly, the two ends of a wire 2| which` has beenyformed with a loop 22 by twisting the saidwire. This loop 22 may beused for attachment of either a nasal or a palatal yappliance. l 1 y Theends of wire 2I are inserted in the vertically spacedapart apertures inthe strip 9, and passing through the loop'22 is a, rod 23, the lower endof which is bent inwardly and upwardly and then rearwardly, so as toprovide a support for the palate. The upper portion ofthe member 23 is`threaded as shown at 23a, A knurled, internally threaded collar 24 isengaged to ride up andldown the threaded portion of member 23 soa-s to,adjust the necessary tension or 'traction onvthe palatal structure. 1E, Referring now more particularly to Figs. 5 and 5: there is disclosedan arcuately formed, horizontally-disposed rod y25, the ends of whichare 'disposed in apertures 8, inthe band l. Along the rod 25 rideperforated bracket members 2B, adapted to receive severally the arms ofa U- shaped yoke or member 2'I. Depending from, but attachedV to saidU-shaped member, are two hookedmembers 28, adapted to enter the nasalorices, so that when the yoke member 2l is properly raised or lowered,the essential uplift or traction or tension will be applied. When thisposition has been determined, set screws 29, are tightened. Lateralmovement is prevented by tightening set screws 29a. v

InFig. 9 only a'single bracket 30 is shown and a single rod 3Ifornisposition in the nasal orice. Set screws 32-and33 are provided` formaintaining the threaded rod 3i securelyin place.` Referring-to Figf'lzthe headband may be Aemployedv to receive a. horizontally disposed metalloopor clip 35, the en ds -ofwhichare disposed L.in Figs. 2, 4 and 6,respectively, the bifurcated portion 3 is pro-vided with a leather strip4l, one end of which may be Stitched or otherwise attached to the bandbeneath, while the other end may be attached preferably by means of asnapfastener da, so as to facilitate kthe reception of an arm oftraction wire 4S, as clearly shown in Fig. 6.

It is quite apparent from the above exhaustive disclosure that my deviceis susceptible of use in divers connections which will readily suggestThe numerous apthemselves to oral surgeons.

ilperiiures 3, of band '1.k This arrangement, as 1 band having anunderlying band and an overlying band having a series of perforationstherein` through which the ends of a wire are adapted to be inserted andbetween which bandssaid ends are adapted to be maintained.

2. An appliance for use in the `treatment of fractures, malformations,etc., of the jaws and contiguousbone structures, comprising aheadbandhaving an underlying band of leather and an overlying band of leatherhaving a series of perforations therein, through which the ends of awireare adapted to be inserted and between which bands said ends are adaptedto be maintained.

3. An appliance for, use in the treatment of fractures andmalformations, etc., of the jaws and contiguous bone structures,vcomprising a headband having an underlying band and a perforatedoverlying band, and a device having its y ends passing through a pair ofsaid perforations l and disposed between said overlapping bands.

plications disclosed are intended to suggest tothe art the manifoldpossibilities of the foregoing 'ap-- paratus. Other applications willreadily occur to those operating in the field, and having indicatedthem, applicant proceeds to claim what he deems n to be his invention.Before doing so, applicant wishes to point out that the mostsatisfactory material out of which to make his headband consists of abase layer of felt, with successive layers of leather, overlaid; butapplicant has no in- 4. An appliance for use in the treatment offractures andl malformations, etc., of the jaw and contiguous bonestructures,y comprising a headband having an underlying leather band anda perforated overlying leather band, and traction and retention wiresand appliances having the ends passingthrcugh said perforations andaccommodated between said bands, with supplemental attachments,contained on or attached to4 said wire. c

5. vAn appliance for use inv oral, plastic or repair surgery comprisinga headband i having a medial strip provided'with vertically arrangedperforations.

6. An appliance vfor use in oral, plastic or repair surgery comprising aheadband having a medial strip provided with verticallyarranged-perforations, and alooped wire having its ends disposed in saidperforations. y

" HARRY L. BISNOFF.

